The Science of Child Sexual Abuse

Note: this file contains the manuscript version of a policy forum
published in Science Magazine, accepted 4 April 2005. This version
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the Science website at http://www.sciencemag.org/cgi/reprint/308/5721/501.pdf.
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On-Line Summary: Child sexual abuse (CSA) involving sexual contact
between an adult and a child has been reported by approximately 20% of women
and 5-10% of men worldwide. A history of CSA leads to serious mental and physical
health problems, substance abuse, and criminality in adulthood. Scientific
study of CSA is currently under-funded, obscured by contentious forensic controversy,
and fragmented by discipline. From public health, economic, ethical, and scientific
perspectives, we recommend interdisciplinary consensus panels and increased
intellectual investment in CSA research, prevention, intervention, and education.

Child sexual abuse (CSA) involving sexual contact between an (usually
male) adult and a child has been reported by 20% of women and 5-10% of men worldwide
(1-3). Surveys likely underestimate prevalence due to underreporting
and memory failure (4-6). Although official reports have declined somewhat
in the U.S. over the past decade (7), close to 90% of sexual abuse cases
are never reported to the authorities (8).

CSA is associated with serious mental and physical health problems,
substance abuse, victimization, and criminality in adulthood (9-12).
Mental health problems include post-traumatic stress disorder, depression, and
suicide (13, 14). CSA may interfere with attachment, emotional regulation,
and major stress response systems (15). CSA has been used as a weapon
of war and genocide and is associated with abduction and human trafficking (2).

Much of the research on CSA has been plagued by non-representative
sampling, deficient controls, and limited statistical power (16). Moreover,
CSA is associated with other forms of victimization (17), which complicates
causal analysis of its role in adult functioning. However, associations in larger
scale community and well-patient samples have been confirmed after controlling
for family dysfunction and other risk factors (18, 19), in longitudinal
investigations that measure pre- and post- CSA functioning (20), and
in twin studies that control for environmental and genetic factors (12, 21).

Most CSA is committed by family members and individuals close to
the child (1), which increases the likelihood of delayed disclosure (22),
unsupportive reactions by caregivers and lack of intervention (8, 23)
and possible memory failure (24, 25, cf. 26). These factors all undermine
the credibility of abuse reports, yet there is evidence that when adults recall
abuse, memory veracity is not correlated with memory persistence (27, 28).
Research on child witness reliability has focused on highly publicized allegations
of abuse by preschool operators, and has emphasized false allegations rather
than false denials (29, 30). Cognitive and neurological mechanisms that
may underlie the forgetting of abuse have been identified (31-33).

Scientific research on CSA is distributed across numerous disciplines,
resulting in fragmented knowledge that is often infused with unstated value
judgments. Consequently, policymakers have difficulty utilizing available scientific
knowledge and gaps in the knowledge base are not well articulated. We recommend
interdisciplinary research initiatives and a series of international consensus
panels on scientific and clinical practice issues related to CSA. This can promote
(a) increased inclusion of CSA education in the curriculum in medical and mental
health fields, (b) improved education of the public, the media, and professionals
working with alleged CSA victims, (c) greater visibility and improved dissemination
of CSA research, (d) increased focus on CSA by researchers in a range of disciplines,
and (e) improved cost-benefit analyses of intervention, including prevention
efforts.

We call on researchers from social science, medical, and criminal
justice fields to gather better information on the prevalence (34), causes,
consequences, prevention, and treatment of CSA. A 1996 report from the Department
of Justice (35) estimated rape and sexual abuse of children to cost $1.5
billion in medical expenses and $23 billion total annually to U.S. victims.
Whereas $2 is spent on research for every $100 dollars in cost for cancer, only
$.05 is spent for every $100 dollars in cost for child maltreatment (36).
The National Child Traumatic Stress Network is a federally funded network of
54 sites providing community-based treatment to children and their families
exposed to a wide range of trauma. The network should be expanded to address
the enormous public health consequences of child trauma, and supported to develop
new forms of treatment. Even creation of a new Institute of Child Abuse and
Interpersonal Violence within the NIH would be justified on the basis of the
emotional and economic cost of these problems